PACS Viewing Via CareWeb

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PACS Viewing Via CareWeb
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PACS Viewing Via CareWeb

• The purpose of this tutorial is to provide an
  overview of how to view and manipulate radiology
  images through CareWeb

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Select a Topic

• What is PACS Web Viewing
• Downloading Software
• Accessing PACS Images
• Selecting Exams to View
• Different Image Views
• Adjusting Window/Level
• Removing Overlay
• Navigating Around Images
• Comparing Two Exams
• Zooming an Image
• Displaying Cine

• Measuring Distances and Angles
• Displaying Pixel Values
• Using Magic Glass
• Setting Display Options
• Understanding TruRez
• Miscellaneous Manipulations
• Resetting the Display Reset
• Changing Interpolation Modes
• Image Information Display
• Save Image to Disk/Clipboard
• Color Display Limitations

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What is PACS Web Viewing?

• Most radiology images captured at BIDMC are
  stored in electronic form in a Picture Archiving
  and Communications System (PACS). PACS Web
  Viewing allows these images to be viewed using a
  PC and a Web Browser conveniently from home or
  office.
• PACS images displayed via the web are for
  reference only and are not approved for primary
  diagnostic use.

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Downloading Software

• Before starting, you may need to download extra
  or updated software. Click here to see if you do.
  If the screen you see looks like this just follow
  the instructions.
• Once the downloads are complete, the screen
  should look like this. Dont click on the
  button, just close the window and return to this
  screen.

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Accessing PACS Images

• Start at the CareGroup Home Page
  http//home.caregroup.harvard.edu

• Select CareWeb in the blue panel on the left hand
  side
• Select Careweb Clinical Lookup from the list
  displayed (or click here)

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Accessing PACS Images (cont.)

• You will need a CCC key to log into CareWeb. (If
  you do not have one call 617-754-8080).
• If you are accessing the web from outside the
  hospital you will also need a SecurID. (If you do
  not have one call 617-754-8080).

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Accessing PACS Images (cont.)

• Enter your CCC key

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Accessing PACS Images (cont.)

• Enter the Name or MRN of the patient. If there is
  more than one match, select the correct patient
  from the list

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Accessing PACS Images (cont.)

• Select Xrays from the tabs

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Accessing PACS Images (cont.)

• Select a Report to view it if you wish

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Accessing PACS Images (cont.)

• Click the BACK button when done

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Accessing PACS Images (cont.)

• Select Show Radiology Images

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Accessing PACS Images (cont.)

• The following screen will appear.

• If you have followed this tutorial from the
  beginning, you have already downloaded all
  required software, so click to view images.

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Selecting Exams to view

• A list of exams will be displayed
• Select the Exam you wish to view
• If the exam is not on line, (Online Status of N),
  it will be fetched from the archives. This could
  take a few minutes depending on the size of the
  study.
• Click on Display Images button

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Series View

• A new browser window will open. If there is more
  than one series in the exam, you will see a
  series browser screen
• Select a series, either to view thumbnail images
  or full size images

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Default Image View

• The default view will look something like this,
  depending on how many images there are
• To exit image viewing, just click Close Window

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Adjusting Window/Level

• Right click on the image and select Tools/Window
  from the menu
• Drag the mouse left-right to change window
  setting
• Drag the mouse up-down to change the level
  setting
• Select the Region Of Interest (ROI) Calculate
  tool, find your ROI and click. The Window/Level
  will be set to the optimum level
• When you have a suitable Window/Level for the
  image, click on the button to propagate the
  setting to other images in the series.

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Setting Window/Level Manually

• You can set Window/Level manually. Right click
  over the image and select Set Window/Level form
  the menu.
• Enter Window and Level values in the dialog box
• Suggested values
• LUNG WINDOW 1600 LEVEL 450
• SOFT TISSUE WINDOW 400 LEVEL 40
• BONE WINDOW 3000 LEVEL 500
• BRAIN/SINUS WINDOW 155 LEVEL 42
• ABD/LIVER WINDOW 342 LEVEL 56
• common window/level for mri are 
• GRADIENT ECHO T2 WINDOW 240 LEVEL 135
• T1 WINDOW 1450 LEVEL 508
• T2 WINDOW 1410 LEVEL 625
• PD WINDOW 775 LEVEL 519

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Removing Overlay

• If desired, you can remove the overlay
  information displayed with each image. Click the
  button. Click it again to restore the
  information display.

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Viewing Different Images

• The arrow buttons control which images are
  displayed. You can move one image at a time or
  one page at a time, forward or backward.
• The lower buttons allow you to navigate to other
  series in the exam.
• Images designated as significant Images from any
  series are gathered together and can be viewed by
  selecting a link next to this flag . In addition,
  Individual images which have been designated as
  Significant Images are marked with this flag.

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Comparing Two Exams

• Select the first exam from the list. Then,
  holding down the Ctrl key, select the exam to
  compare. The Display Images button changes to
  Compare Exams. The image display screen splits
  in half, showing each exam in its own window.
• Use the button to lock the image controls
  between the exams so that moving to the next
  image on one exam automatically advances the
  other.

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Zooming an Image

• Right Click on the mouse and select the
  Continuous Zoom tool from the Tools menu The
  cursor shape for the Continuous Zoom tool is
• Hold the left mouse button down and move the
  mouse up to increase the zoom and move the mouse
  down to decrease the zoom.
• When in zoom mode, you can switch to pan / scroll
  mode by holding down the Shift key. You can
  switch back to zoom by releasing the Shift key.
  Fixed zoom factors can also be selected using
  Zoom Presets.

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Panning a Zoomed Image

• Right Click on the mouse and select the Pan tool
  from the Tools menu. The cursor shape for the Pan
  tool is
• If an image has been zoomed, hold down the left
  mouse button to move the image within the viewing
  area. If the image has not been zoomed, the pan
  tool has no effect. When in pan mode, you can
  switch to Continuous Zoom mode by holding down
  the Shift key.

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Zoom Preset

• Right Click on the mouse and select Zoom Preset.
  This allows you to select specific zoom values.
• Fit to View This is the default display mode,
  where the image is zoomed to be as large as
  possible while still fitting in the display area.
• Full Res 1x This option displays the image at its
  full size and with 100 of the image data (i.e.
  TruRez Full).
• 1x, 2x, 3x,4x These options set the zoom for the
  image by factors of 1, 2, 3, and 4 respectively.

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Cine through an MR or CT

• Right Click on the mouse and select the Manual
  Cine tool from the Tools menu
• The cursor shape for all the Manual Cine tool is
• The manual cine tool allows you to scroll forward
  or backward through a stack of images. To use the
  Manual Cine tool, hold down the left mouse button
  over an image. Drag the mouse down to scroll
  forward through the images and upwards to scroll
  backwards through the images. This looks
  something like a short movie, or cinema.
• Hold down the Shift key and the click the left
  mouse button once to step backward through the
  stack of images at a rate of one image per click.
  Click the left mouse button once (without holding
  down the Shift key) to step forward through the
  stack of images at a rate of one image per click.

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Cine (cont.)

• Images are loaded one at a time when displayed
  using the Manual Cine tool. You can use the Load
  Stack Function to preload all images in the
  series into the cache. To use the Load Stack
  option, place your cursor over an image and
  right-click. Select Load Stack. Note that the
  Load Stack function may not be available until
  you first select the Manual Cine tool.
• While using the Manual Cine tool, you can display
  a particular image immediately if you know the
  image number by using the Go to Image option.
• To select the Go to Image option, place your
  cursor over an image and right-click.
• Select Go to Image A following dialog box will
  appear. Enter the image number that you want to
  go to and click OK. The image associated with the
  entered number is displayed on the screen

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Measuring Distances

• To select the Measure Distance tool, place your
  cursor over an image and right click.
• Select Tools and Measure Distance.
• The cursor shape for the Measure Distance tool
  is
• To draw a line, press the left mouse button to
  set the first point and then drag the mouse while
  holding the left mouse button down. When you have
  completed the line, release the mouse. The length
  of the line is displayed, in mm, unless the pixel
  size is unknown, in which case the length will be
  shown in pixels (px).
• To erase a distance line, you can use the Delete
  Tool using the Shift key.

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Measuring Angles

• To select the Measure Angle or Cobb Angle tool,
  place your cursor over an image and right-click.
• Select Tools and Measure Angle or Cobb Angle. The
  cursor shapes for the Measure Angle or Cobb Angle
  tool are
• This is a 4-point angle measurement tool,
  allowing it to be used for Cobb angle
  measurements, in addition to standard angle
  measurements.
• To measure an angle, first draw 2 lines on the
  image. To draw a line, press the left mouse
  button to set the first point and then drag the
  mouse while holding the left mouse button down.
  Note that the number 1 is shown beside the cursor
  to indicate that you are drawing the first line.
  When you have completed the line, release the
  mouse. The number will now change to a 2 and you
  can then draw the second line in the same manner.
• Once both lines are drawn, the angle between them
  is calculated. Note that two angles are shown, in
  the format A/B, where A is the interior angle and
  B is the exterior angle. The lines do not need to
  intersect or touch to calculate the angle.
• To erase an angle, you can use the Delete Tool
  using the Shift key.

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Displaying Pixel Values

• Select the Pixel Lens tool, place your cursor
  over an image and right-click. Select Tools and
  Pixel Lens.
• The cursor shape for the Pixel Lens tool is
• To use the pixel lens tool, press and hold down
  the left mouse button while over an image and
  move the mouse over the image. The value of the
  pixel directly underneath the center of the
  cursor is displayed.
• Note that the value shown is converted into the
  appropriate units if necessary, e.g. Hounsfield
  units for CT images.

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Magic Glass

• The magic glass tools allow a rectangular
  subsection of the image to be selected and viewed
  differently- magnified, inverted, or sharpened.
• Select the Magic Glass tool, place your cursor
  over an image and right-click.
• The cursor shape for all the Magic Glass tools
  is
• Select Tools and either Magic Glass 2x, Magic
  Glass Invert, or Magic Glass Sharpen.
• Magic Glass 2x displays the selected region at 2x
  magnification.
• Magic Glass Invert displays the selected region
  with an inverted grayscale.
• Magic Glass Sharpen displays the selected region
  with a sharpening filter applied.

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Magic Glass (cont.)

• To use the Magic Glass tool, press and hold the
  left mouse button over an image and move the
  mouse pointer around the image to view other
  areas of the image
• To change the size and shape of the selected
  region, hold down the Ctrl key while moving the
  mouse.
• To change the Window Level of the selected
  region, hold down the Alt key while moving the
  mouse.
• To change the magnification of the selected
  region, hold down the Shift key while moving the
  mouse.
• Any window level or magnification changes made to
  the displayed region are temporary and do not
  affect the way the image is displayed.

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Display Options

• The Display options allow you to show the
  graphics and annotation associated with the
  images selected. To select the Display options,
  place your cursor over an image and right-click.
  Click Display and the desired option
• Image Overlay To select the Image Overlay
  option, click Display and Image Overlay. This
  option turns the system overlay text (e.g.
  Patient Name and ID) on or off. The overlay text
  is always turned on by default. The size of the
  font used decreases with the image upcount, to
  minimize the area of the image obscured by the
  text. If the selected image upcount makes the
  images too small (e.g. 9 on 1), then the overlay
  text is turned off automatically.
• Local Annotations To select the Local
  Annotations option, click Display and Local
  Annotations. This option toggles on or off any
  user-created distance/angle lines. This option is
  always turned on by default.

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Display Options (cont.)

• Overlay Graphics To select the Overlay Graphics
  option, click Display and Overlay Graphics. This
  option turns on or off the display of any DICOM
  6000 graphical overlay information that was part
  of the original image. This option is always
  turned on by default.
• Text Annotations To select the Text Annotations
  option, click Display and Text Annotations. This
  option toggles on or off the display of any text
  annotations that were created and saved by the
  PACS Workstation and that are part of the
  original image. Text annotations cannot be
  permanently modified in any way using PathSpeed
  Web. This option is always turned on by default.
• All On / All Off To select the All On or All
  Off options, click Display and All On or All Off.
  These two options toggle all of the annotations
  ON or all of the annotations OFF. All of the
  annotations are set ON by default.

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TruRez

• TruRez enables the display of images without
  transferring 100 of the image data. Only the
  necessary amount of image data is transferred for
  the monitor size being used. TruRez reduces
  network load.
• The lower left corner of the image indicates if
  an image is TruRez. If so, two numbers, such as
  4/6 will show. If an image is not stored in
  TruRez format, the display in the lower left
  corner shows FullRes.
• To select the TruRez level, place your cursor
  over an image and right-click. Select TruRez
  Levels and a level of image data transmitted.
• The Continuous Zoom tool automatically retrieves
  the next level of TruRez data when needed.
• The Magic Glass 2X tool does NOT alter the TruRez
  level of the image being displayed.

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Other Manipulations

• All the manipulations, except Invert Gray
  Scale,can be applied more than once. To select
  the Manipulations options, place your cursor over
  an image and rightclick. Select Manipulations and
  one of the following options.
• Flip Horizontal This option flips the image
  left/right around the vertical axis through the
  middle of the image.
• Flip Vertical This option flips the image up/down
  around the horizontal axis through the middle of
  the image.
• Rotate 90 CCW This option rotates the image 90
  degrees counter-clockwise.
• Rotate 90 CW This option rotates the image 90
  degrees clockwise.

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Other Manipulations (cont.)

• Invert Gray Scale This option inverts the grey
  scale of the image, so that areas that were black
  are now shown in white, and vice-versa. Invert
  Gray Scale is a toggle state. If the images gray
  scale is inverted from its normal state, then the
  menu item has a check mark next to it. If the
  image is in its normal gray scale state, no check
  mark is present.
• Continuous Zoom 2x This applies a relative zoom
  of 2 to the image, making it larger. This command
  automatically retrieves the next level of TruRez
  data, if needed, to maintain image quality.
• Continuous Zoom 1/2x This applies a relative zoom
  of 0.5 to the image, making it smaller.

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Display Reset

• Options are available to reset the display state
  of the image. A check mark next to an option
  indicates that the image is already being
  displayed in the reset state for that option. To
  select a Reset option, place your cursor over an
  image and rightclick. Select Reset and either
  Window Level or Orientation.
• Window Level This option restores the window and
  level settings to the original values (when the
  image was first displayed). This is also
  available via the reset button.
• Orientation This option restores the flip and
  rotate settings to the original values (when
  theimage was first displayed).

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Interpolation Modes

• Scaling options are available to change the
  interpolation mode used when images are
  displayed. A check mark next to the option
  indicates the current scaling mode. To select a
  Scaling Mode option, place your cursor over an
  image and right-click. Select Scaling Mode and
  one of the following options
• Nearest Neighbor This option applies nearest
  neighbor interpolation to images. This method is
  fast, but gives poor results for significantly
  zoomed images.
• Bilinear Interpolation This option applies
  bilinear interpolation to images. This is the
  default setting for RGB images. This method gives
  better results than Nearest Neighbor, but is
  slower.
• Bicubic Interpolation This option applies bicubic
  interpolation to images. This is the default
  setting for monochrome images. This method may
  give better results than Bilinear Interpolation,
  but is slower.

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Image Information Display

• The Image Information option displays a window
  that shows information about a particular image.
  The window displays attributes from the PACS
  database, as well as the image header, and
  identifies any header values that differ from the
  PACS database values displayed (values may differ
  due to the profiling used, or if exams or
  patients have been merged). To select the Image
  Information option, place your cursor over an
  image and rightclick. Select Image Information.
• Note that multiple image information windows can
  be displayed at the same time. 

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Image Printing

• The Print Image option allows you to print the
  displayed image to a local printer.
• To select the Print Image option, place your
  cursor over an image and right-click. Select
  Print Image.
• Note Images are printed "fit to page",
  regardless of display size or zoom factor.

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Image Save to File

• The Save Image options are available to save a
  displayed image to a bitmap (.bmp) file or to
  the clipboard. To select a Save Image option,
  place your cursor over an image and right-click.
  Select Save Image and one of the following
  options.
• Whole Image In Bitmap Format Selecting this
  option brings up a standard save dialog to choose
  the folder and file name to save the image to.
  This option saves the entire image, even portions
  that may not be displayed, to a bitmap (.bmp)
  using the currently applied display options. Any
  overlay information or measurement lines
  currently displayed on the image are not saved.
  Any overlay graphics that came with the image are
  saved if they were displayed when this option was
  selected.
• Image Display In Bitmap Format Selecting this
  option brings up a standard save dialog to choose
  the folder and file name to save the image to.
  This option saves only the portion of the image
  that is displayed to a bitmap (.bmp) using the
  currently applied display options. Any overlay
  information or measurement lines currently
  displayed on the image are also saved. Any
  overlay graphics that came with the image are
  saved if they were displayed when this option was
  selected.

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Image Save to Clipboard

• Select Save Image and Image Display To Clipboard
  This is the same as the Image Display In Bitmap
  Format option, except that the output goes to the
  clipboard instead of a file and does not bring up
  a dialog. This option saves only the portion of
  the image that is displayed to a bitmap (.bmp)
  using the currently applied display options. Any
  overlay information or measurement lines
  currently displayed on the image are also saved.
  Any overlay graphics that came with the image are
  saved if they were displayed when this option was
  selected. 
• Note These options only save a copy of the
  displayed image as a picture that can be used
  elsewhere. PathSpeed Web cannot save and/or
  modify images on the PACS system.

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Color Display Limitations

• RGB color images can be displayed, but the
  following tools and options are not available for
  RGB color images
• Tools gt Window Level
• Tools gt Pixel Lens
• Tools gt Magic Glass Invert
• Tools gt Magic Glass Sharpen
• Tools gt ROI Calculate Window Level
• Set Window / Level
• Transforms gt Invert Gray Scale
• Reset gt Window Level

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